The Role of Lifestyle Intervention, in Addition to Drugs, for Diabetic Kidney Disease with Sarcopenic Obesity

Abstract

Diabetic kidney disease is the leading cause of end-stage renal disease in developing and developed countries. The growing prevalence and clinical challenges of sarcopenic obesity have been associated with the frailty and disability of diabetic kidney disease. It has been reported that insulin resistance, chronic inflammation, enhanced oxidative stress and lipotoxicity contribute to the pathophysiology of muscle loss and visceral fat accumulation. Sarcopenic obesity, which is diagnosed with dual-energy X-ray absorptiometry, is associated with worse outcomes in kidney disease. Growing evidence indicates that adherence to healthy lifestyles, including low protein diet, proper carbohydrate control, vitamin D supplement, and regular physical training, has been shown to improve clinical prognosis. Based on the higher risk of sarcopenic-obesity-related renal function decline, it has led to the exploration and investigation of the pathophysiology, clinical aspects, and novel approach of these controversial issues in daily practice.

Interactive effects of intrinsic capacity and obesity on the KDIGO chronic kidney disease risk classification in older patients with type 2 diabetes mellitus

“…In a literature review, sarcopenic obesity was associated with frailty among older adults [ 45 ], and with the risk of coronary artery disease and all-cause mortality [ 46 , 47 ]. Recent studies have further shown an association between sarcopenic obesity and chronic renal disease, especially in those with diabetes-related renal impairment [ 48 ]. This may explain why insulin resistance, the over-expression of adipokines, and inflammation processes have been associated with obesity and CKD progression [ 49 – 53 ].…”

“…The interactions among muscle wasting, obesity and diabetic nephropathy are unclear. Advanced glycosylated end products (AGEs) have been associated with hyperglycemia, muscle wasting, and impaired renal function in vivo and in vitro [ 54 ], In addition, insulin resistance, oxidative stress, inflammation, uremic toxin toxicity, metabolic acidosis, vitamin D deficiency and protein energy wasting occur in patients with diabetic nephropathy, and they also result in muscle loss and abnormal fat deposition in CKD patients [ 48 ]. Taken together, these findings show that it is important to detect and evaluate sarcopenic obesity to allow for the more intensive management of diabetes and renal dysfunction in older patients.…”

“…Most of the current strategies to prevent the complications of diabetic nephropathy still focus on preventing hyperglycemia, the early diagnosis of kidney disease, and antihypertensive treatment to reduce renin-angiotensin system activity [48]. To reduce complications and disability directly or indirectly caused by diabetes, the American Diabetes Association has Tang et al Diabetology & Metabolic Syndrome (2023) 15:1 also launched numerous projects, such as the Diabetes Self-Management Education and Support (DSMES) and ADCES7 Self-Care Behaviors ™ to help clinical physician and patients to monitor clinical, psychosocial and behavioral aspects of diabetes [55,56].…”

Low carbohydrate intake correlates with trends of insulin resistance and metabolic acidosis in healthy lean individuals

“…It is irrefutable that any diet based on restrictions and exclusions of certain foods will induce a possible increase in the risk of mineral deficiencies and electrolyte imbalance. In fact, studies have shown that consuming a low-carbohydrate diet while maintaining a high intake of protein can lead to a disturbance in fluid and electrolytes, which can further cause kidney damage ( 40 , 41 ).…”

Sarcopenic obesity — a current problem of modern geriatrics

“…(2022) полагают, что изменение образа жизни, физическая активность и снижение жировой массы тела с помощью диеты сами по себе приводят к улучшению физической формы и сохранению мышечной массы. На фоне диабетической нефропатии необходимыми являются предотвращение гипергликемии, ранняя диагностика ХБП, своевременное лечение антигипертензивными препаратами, снижающими активность ренинангиотензиновой системы, и контроль уровня холестерина [49].…”